Accelerating TB/HIV activities in Zambia Alwyn Mwinga 2007 HIV Implementers Meeting 20 June 2007

Overview of presentation Background Progress in implementation of TB/HIV activities Scale up plan from March 07 meeting Plus up activities Outstanding issues

Background information Zambia Population – 11 million 9 provinces, 72 districts TB Program (current) National Unit – Manager, 2 program officers Provincial TB focal person District TB/Leprosy focal persons New Structure 5 staff in central unit, Provincial level – integrated in Communicable disease unit District TB/Leprosy Focal persons

Progress in implementation of TB/HIV activities Establish mechanism of coordination TB/HIV coordinating body at all levels National body – √ Provincial and district – TOR developed Surveillance of HIV in TB patients Data will be obtained from routinely collected data Joint TB/HIV planning Not yet happening, HIV program officers (ART, VCT, PMTCT) part of coordinating body Conduct monitoring and evaluation Registers have HIV data (HIV status, ART, CTX)

Progress in implementation of TB/HIV activities Reduce burden of TB in PLWHA Establish intensified case finding TB symptom screen part of ART eligibility and follow up. Introduce IPT Not accepted as public health intervention, pending results of Botswana experience. Ensure TB infection control in health care and congregate settings Plan to develop guidelines

Progress in implementation of TB/HIV activities Reduce the burden of HIV in TB patients Provide HIV counseling and testing - PICT introduced as standard of care Introduce HIV prevention methods - Plans included in 2006 – 2011 TB National Strategic Plan Introduce cotrimoxazole- Variable included in revised registers, guidelines not distributed, supply chain not addressed

Progress in implementation of TB/HIV activities Ensure HIV care and support Links exist with HBHC providers, but needs to be strengthened Introduce ARV therapy Guidelines for ARVs in TB patients developed, referrals occurring and reported in TB register

Achievements PICT manual developed 50 trainers trained Close to 500 health workers trained in DCT TB recording and reporting forms revised and in use since 2 nd quarter 2006 All districts reporting TB/HIV data TB/HIV data reviewed as part of TB review meetings

Scale up plan for TB/HIV USG/WHO/Gates meeting March 2007 Zambia Team – National ART coordinator, head of TB NRL, USG focal person Reference document National TB Strategic Plan TB/HIV guidelines National Laboratory plan Vision Diagnose and treat HIV infection in all TB patients Diagnose and treat active TB in all HIV infected settings Prevent TB transmission in health care settings

Brief outline of scale-up plan Areas covered include Policy, Training, Supply chain management, Laboratory, Physical infrastructure, Human resources Supervision and M&E

Process followed Meeting with National TB Manager Plan discussed and accepted Briefing of TB/HIV coordinating body Report provided to PEPFAR team TB/HIV working group Planning for Plus-up funds National program, USG

PEPFAR supported partners in TB/HIV JHPIEGO Development of training materials, guidelines, ToT Zambia Defense Forces CIDRZ Lusaka Province, TA to 3 Provincial Health Offices FHI/Zambia Prevention Care and Treatment 5 northern Provinces CARE International DCT, community linkages, IEC

PEPFAR supported partners in TB/HIV CRS/AIDS Relief Faith based and private institutions Provincial Health office 4 southern provinces Ministry of Health National coordination and supervision SHARE GDA – mining and agribusiness Churches Health Association of Zambia Faith based institutions

Activities included in Plus-up funds Policy Funding provided for printing and distribution of HIV guidelines, training materials for DCT development of Infection control guidelines Training ToT in PICT 3 trainers per district, including the ZDF Health staff DCT ART/OI management TB diagnosis and management for ART service providers

Activities included in Plus-up funds Training (cont) Lay counselors/peer educator Cross referrals between TB and ARV program Training counselors Increase community involvement, IEC Evaluation of smear negative/EPTB guidelines

Activities included in Plus-up funds Supply Chain Management Procurement of HIV test kits, CD4 reagents and biochemistry reagents Laboratory Improved laboratory equipment, infrastructure Use of low cost fluorescence microscopy Strengthen national EQA system

Activities included in Plus-up funds Physical Infrastructure Renovations to provide conducive environment and reduce risk of infection Human resource National Technical Advisor for EQA TB/HIV officer at central level (COP07) Supervision and M&E Technical Support supervision at all levels by national program Mentoring and TA by implementing partner to districts Improve data collection using national forms, data review meetings

Outstanding issues – COP08 Cotrimoxazole Distribution of guidelines, training of staff Supply management, tracking Strengthened linkages between TB and HIV services TB screening for PLWH Infection control IEC

Other support for TB activities TB CAP Support for TB control including TB/HIV in 3 provinces ( will scale up to 5 provinces) Global Fund Support for strengthening TB DOTS KNCV/CIDA National and provincial level support, will support Data Officer in central unit